| NPI | 1770671547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: KY 611539) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 34741) |
| 207L00000X Anesthesiology (Licence: KY 34741) | |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: KY 611539) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 34741) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2025-02-13 |